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How is bipolar disorder diagnosed?
Bipolar disorder is diagnosed as part of a complete psychiatric or other mental health evaluation. The evaluation includes a review of current and past symptoms, psychiatric and medical history, family history, social history, and substance-use history. In addition, there is an assessment of the current mental status. Although there are no tests or procedures to diagnose bipolar disorder, in certain circumstances tests may be ordered in addition to a request for physical examination in order to rule out any general medical conditions as a cause for the psychiatric symptoms. Depending on the circumstances, the clinician may want to obtain collateral information from family members. Based upon the symptoms, history, and mental status, a specific diagnosis can be made. The DSM-IV-TR defines six criteria sets for the diagnoses of bipolar I disorder, based upon the type of episode a person has last experienced--mania, hypomania, major depressive, or mixed.
A manic episode is defined by the following:
Patients will have an abnormally and persistently elevated, expansive, or irritable mood lasting at least one week (or less if hospitalized), along with three or more of the following:
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a. Inflated self-esteem or grandiosity
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b. Decreased need for sleep
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c. More talkative than usual or pressure to keep talking
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d. Flight of ideas or racing thoughts
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e. Distractibility
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f. An increase in goal-directed activity or psychomotor agitation
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g. Excessive involvement in pleasurable activities that have a high potential for painful consequences
Symptoms of a manic episode are severe enough to cause marked functional impairment or hospitalization and are not a result of substance use or a medical condistion. A hypomanic episode is defined by the same symptoms but is not severe enough to cause a marked impairment of functioning or hospitalization. Rather, hypomanic symptoms are a change from the afflicted individual's normal functioning and need to last at least four days. A major depressive episode is defined by the following symptoms:
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Depressed mood most of the day, nearly every day, or
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Loss of interest or pleasure in activities, with four or more of the following:
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Significant weight loss (not from dieting) or weight gain or change in appetite
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Feelings of worthlessness or inappropriate guilt
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Decreased concentration
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Insomnia or hypersomnia (excessive sleep)
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Psychomotor agitation or retardation
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Fatigue or loss of energy
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Recurrent thought of death or suicidal ideation
Again, significant functional impairment needs to be present, and symptoms can not be a result of a substance or a medical condition. A mixed episode is defined as the presence of both a major depressive and a manic episode for at least one week.
The six criteria sets for diagnosing bipolar I disorder are: single manic episode, most recent episode hypomanic, most recent episode manic, most recent episode mixed, most recent episode depressed, and most recent episode unspecified.
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